Harvard Pilgrim Loses Appeal Over $800-Per-Day Treatment

Harvard Pilgrim Health Care couldn’t convince an appeals court to uphold a ruling that it didn’t have to pay for four months of treatment a college student with psychotic disorder received at an out-of-network residential treatment facility.

The district court was mistaken by not considering an expanded version of the student’s administrative record when the parties had agreed to open it to include additional medical reports, the U.S. Court of Appeals for the First Circuit held Sept. 6.

The ruling is a victory for the student, who sued Harvard Pilgrim in 2015 seeking to recover nearly $100,000 in medical bills ...